Autonomic Changes Are More Durable After Radiofrequency Than Pulsed Electric Field Pulmonary Vein Ablation

• DOI: 10.1016/j.jacep.2022.04.017
• Publication Date: 2022-06-29T21:11:38Z
• Authors: Predrag Stojadinović; Dan Wichterle; Petr Peichl; Hiroshi Nakagawa; Robert Čihák; Jana Hašková; Josef Kautzner
• Keywords: 03 medical and health sciences; 0302 clinical medicine; Pulmonary Veins; Atrial Fibrillation; Catheter Ablation; Humans; Autonomic Nervous System; Sinoatrial Node

Pulmonary vein isolation (PVI) by radiofrequency (RF) energy is associated with a collateral ganglionated plexi ablation. Pulsed electric field (PEF) is a nonthermal energy source that preferentially affects the myocardial cells and spares neural tissue.This study investigated whether PVI by a PEF compared with RF energy will result in less prominent alteration of the cardiac autonomic nervous system.A total of 31 patients with atrial fibrillation underwent PVI using a novel lattice-tip catheter and PEF energy (n = 18) or a conventional irrigated-tip catheter and RF energy (n = 13). The response of the sinoatrial node and atrioventricular node to extracardiac high-frequency, high-output, right vagal nerve stimulation was evaluated at baseline and during and at the end of the ablation procedure. Substantial reduction in responsiveness was arbitrarily defined as stimulation-inducible pause <1.5 seconds.Reduced response of the sinoatrial node was documented in 13 of 13 (100%) and 6 of 18 (33%) patients (P = 0.0001) in RF and PEF groups, respectively. Reduced response of the atrioventricular node was found in 10 of 11 (93%) and 6 of 18 (33%) patients (P = 0.002) in RF and PEF groups, respectively. The major effects were observed predominantly during ablation around the right pulmonary veins. Early recovery of ganglionated plexi function was noticed only in the PEF ablation group. RF ablation resulted in higher acceleration of the sinus rhythm compared with PEF ablation (20 ± 13 beats/min vs 12 ± 10 beats/min; P = 0.04).PEF compared with RF energy used for PVI induces significantly weaker and less durable suppression of cardiac autonomic regulations.